Consideraciones en el diagnóstico de psoriasis oral: presentación de un caso clínico

Este artículo comenta las dificultades de hacer un diagnóstico definitivo de psoriasis oral basado en la evidencia clínica e histológica. Se presenta un joven varón negro con múltiples lesiones que muestran erosiones, fisuras y escaras amarillentas en el borde bermellón de ambos labios. También tenía áreas eritematosas-erosivas en la encía, una lengua fisurada que mostraba áreas grisáceas en su superficie ventral, lesiones blanquecinas y lesiones longitudinales en el paladar duro junto lesiones entrelazadas en el paladar blando. Las biopsias del labio inferior , la encía y el paladar blando mostraron hiperqueratosis, espongiosis, acantosis, y elongación de las crestas epiteliales. Además, se observaron micro-abscesos intraepiteliales de Munro. Estos resultados son coincidentes con psoriasis oral. No tenía las lesiones cutáneas típicas ni una historia familiar de psoriasis.This paper discusses the difficulties in making a definitive diagnosis of oral psoriasis based upon clinical and histological evidence only. A young black male presented with multiple lesions showing erosions, fissures, and yellowish scales on the vermilion borders of both lips. He also had erythematous-erosive areas on the gingivae, a fissured tongue showing greyish areas on its ventral surface, whitish lesions and longitudinal sulci in the hard palate with lacelike lesions on the soft palate. Biopsies from the lower lip, gingiva and soft palate showed hyperkeratosis, spongiosis, acanthosis, and elongation of rete ridges. In addition, collections intraepithelial micro-abscesses of Munro were observed. These findings are consistent with oral psoriasis. Typical cutaneous lesions and a family history of psoriasis were absent

Idiopathic sialadenosis involving parotid and submandibular glands. A case report.

AbstractThis article reports a case in which a patient, an adult black male, was diagnosed as having sialadenosis of an idiopathic type, since clinical, computed tomography and laboratory examinations did not disclose any other abnormalities that could be associated with the glandular swelling.  As this condition is quite harmless, requiring no intervention, unless for aesthetic reason, the patient was dismissed, being monitored sporadically.  But after 8 months since the first consultation, the patient was diagnosed as having an advanced esophageal squamous cell carcinoma, and eventually died of this disease. This report, therefore, raises the question whether there was any relation with the sialadenosis and the esophageal carcinoma. This question is very speculative, but it stands as a notice for clinicians in future cases of idiopathic sialadenosis to evaluate the patient for an underlying malignant disease.

Preparaciones de base líquida vs. citología convencional: adecuación de las muestras y coincidencia de diagnóstico en lesiones orales

Objetivo: Comparar la efectividad de la muestra y la coincidencia de diagnostico entre preparaciones de base liquida y frotis convencionales en lesiones orales, y probar la viabilidad de la prueba inmuno-citoquimica en preparaciones de base liquida de lesiones de carcinoma oral. Material y Metodos: Se obtuvieron muestras de 44 pacientes. Primeramente se prepararon frotis convencionales, usando un dispositivo cytobrush. A continuacion se sumergio el cepillo que contenia el material residual en un liquido conservante. La muestra en el mismo fue procesada de acuerdo con las indicaciones del fabricante (AutoCyte, Inc. Elon College, North Carolina, USA). Se tineron preparaciones de ambas tecnicas de acuerdo con el metodo de Papanicolaou. Para la prueba inmuno-citoquimica se usaron conjuntamente AE1/AE3 (Dako, CA, USA) para las lesiones de carcinoma oral, de acuerdo con el metodo de la Estreptovidina-biotina-peroxidasa. Se uso la prueba exacta de Fisher; fijandose la probabilidad significativa en p . 0.05. Resultados: Ambas tecnicas coincidieron en el diagnostico citologico en todos los casos donde se uso una muestra adecuada; en 3 casos el frotis convencional mostro hipocelularidad y, por lo tanto, resulto inadecuado para el analisis. En el analisis de muestras, la citologia de base liquida mostro una mejora general estadisticamente significativa), de un 41% en espesura de frotis y de un 66% en la distribucion de celulas (p . 0.05), ademas de una reduccion en la superposicion de celulas y la presencia de sangre (p . 0.05). La morfologia celular se observó mejor en las preparaciones de base líquida. Las reacciones de la prueba inmuno-citoquímica fueron positivas en todos los casos de malignidad, siendo especialmente clara la observación de células inmuno-marcadas. Conclusión: Tanto las preparaciones de base líquida como los frotis convencionales son dignos de confianza desde el punto de vista del diagnóstico; el método de base líquida mostró una mejora general en la preservación de muestras, adecuación de ejemplares, observación de morfología celular y reproducibilidad.Objective: To compare specimen adequacy and diagnostic agreement between liquid-based preparations and conventional smears in oral lesions, and to test the viability of immunocytochemical assay in liquid-based preparations from oral carcinoma lesions. Material and Methods: Samples were collected from 44 patients. Conventional smears were prepared first, using a cytobrush device. Then the brush, containing the residual material, was immersed in a preservative fluid. The sample in the preservative fluid was processed according to the manufacturer directions (AutoCyte, Inc. Elon College, North Carolina, USA). Slides of both techniques were stained by Papanicolaou method. For immunocytochemical assay, a cytokeratin pool AE1/AE3 (Dako, CA, USA) was applied in liquid-based preparations from oral carcinoma lesions following the Streptavidin-biotinperoxidase method. Fisher's exact test was used; significance was set for p = 0.05. Results: Both techniques agreed on cytologic diagnosis in every case they yielded an adequate specimen; in 3 cases conventional smear resulted in hypocellularity and therefore inadequate for analysis. On specimen analysis, the liquid-based cytology demonstrated a statistically significant, 41% overall improvement in smear thickness and 66% in cell distribution (p = 0.05), and a reduction in cell overlapping and presence of blood (p = 0.05). The cell morphology was better visualized in the liquid-based preparations. The immunocytochemical assay reactions were positive in all malignant cases, the visualization of the immu-nostained cells being especially clear. Conclusion: Both, the liquid-based preparation and conventional smear, are diagnostically reliable; the liquid-based method showed an overall improvement on sample preservation, specimen adequacy, visualization of cell morphology and reproducibility

Analysis of a possible association between oral lichen planus and drug intake. A controlled study

Objectives: To investigate whether daily systemic and/or topical medication contributes to the development of oral lichen planus (OLP) lesions. Study Design: The study involved 110 OLP patients and 76 control subjects, matched by age, race and sex. The analyzed data included medical records, drug intake and topical medication. Criteria for analysis of drug intake included: (1) ATC-code drug classification; (2) number of different drugs used daily in the categories of monopharmacy (1 drug), minor polypharmacy (2 4 drugs), and major polypharmacy (> 5 drugs); and (3) drugs implicated in lichenoid reactions (DILRs). Results: Sixty (54.5%) of the 110 OLP patients reported daily medication (prior to the appearance of the OLP lesion) compared to 52 (68.4%) of the 76 control subjects. No statistical difference was found between the two groups in terms of systemic diseases, number of medicated individuals in the categories of mono- and polypharmacy, nor use of DILRs (P > 0.05). Regarding the clinical forms and site of involvement, a statistically significant difference was only found for the clinical erosive form of OLP, seen more frequently in non-DILR (P = 0.04) and nonmedicated OLP patients (P = 0.02) than in DILR OLP patients. Daily use of topical oral medication was reported by 2 (1.8%) OLP patients and 1 (1.3%) control subject. Conclusions: It seems that the use of systemic medication does not lead to a significant increase in the incidence of OLP lesions. For their part, lichenoid drug reactions are likely to occur only in a very low percentage of patients. © Medicina Oral S. L

Systemic treatment in severe cases of recurrent aphthous stomatitis: an open trial

PURPOSE: This study aimed to evaluate the efficacy of the systemic drugs thalidomide, dapsone, colchicine, and pentoxifylline in the treatment of severe manifestations of RAS. METHODS: An open, 4-year clinical trial was carried out for 21 consecutive patients with severe RAS. Initially, patients were given a 2-week course of prednisone to bring them to a baseline status. Simultaneously, one of the four test drugs was assigned to each patient to be taken for a period of 6 months. During the course of the trial, patients were switched to one of the other three drugs whenever side effects or a lack of satisfactory results occurred, and the 6-month limit of the treatment was then reset. RESULTS: The most efficient and best-tolerated drug was thalidomide, which was administered to a total of eight patients and resulted in complete remission in seven (87.5%). Dapsone was prescribed for a total of nine patients, of whom eight (89%) showed improvement in their symptoms, while five showed complete remission. Colchicine was administered to a total of ten patients, with benefits observed in nine (90%), of whom four showed complete remission. Pentoxyfilline was administered to a total of five patients, with benefits observed in three (60%), of whom one patient showed complete remission. CONCLUSION: The therapeutic methods used in this trial provided significant symptom relief. Patients experienced relapses of the lesions; however, this occurred after withdrawal of their medication during the follow-up period

Double-blind, crossover, placebo-controlled clinical trial with clobetasol propionate in desquamative gingivitis

The aim of this study was to evaluate the efficacy of a 0.05% clobetasol propionate ointment administered in trays to 22 patients with desquamative gingivitis in a double-blind, crossover, placebo-controlled trial. Patients received container number 1 and were instructed to apply the ointment 3 times a day for 2 weeks, and to reduce the application to once a day in the third week. Next, the patients were then instructed to discontinue the treatment for 2 weeks, and were then given container 2, used in the same way and for the same length of time as container 1. Regarding signs, 17 patients presented some improvement, while 5 experienced worsening with clobetasol propionate. With the placebo, 14 patients presented some improvement, and 8 patients presented worsening. For symptoms, there was complete improvement in 2 patients, partial improvement in 12, no response in 7, and worsening in 1 with clobetasol propionate. With the placebo, there was partial improvement in 8 patients, no response in 12 and worsening in 2. No statistically significant difference was found between clobetasol and placebo (p>0.05). Within the period designed to treat the gingival lesions of the patients, clobetasol propionate did not significantly outperform the placebo.O objetivo deste estudo foi avaliar a eficácia do propionato de clobetasol a 0,05% administrada com moldeiras em 22 pacientes com gengivite descamativa por meio de estudo duplo-cego, cruzado, placebo-controlado. Pacientes receberam bisnaga número 1 e foram instruídos a aplicar a pomada 3 vezes ao dia por um período de 2 semanas, e reduzir a aplicação para 1 vez ao dia na terceira semana. Os pacientes foram instruídos a suspender o tratamento por 2 semanas, e então receberam a bisnaga 2, usando-a da mesma maneira que o container 1. Com relação aos sinais, 17 pacientes apresentaram alguma melhora, enquanto 5 apresentaram piora com o propionato de clobetasol. Com o uso do placebo, 14 pacientes apresentaram alguma melhora, e 8 pacientes apresentaram piora do seu quadro clínico. Com relação aos sintomas, houve completa melhora em 2 pacientes, melhora parcial em 12, ausência de resposta em 7, e piora em 1 pacientes durante o uso do propionato de clobetasol. Com o uso do placebo, houve melhora parcial em 8 pacientes, ausência de resposta em 12 e piora dos sintomas em 2 pacientes. Não foi verificada diferença estatisticamente significante em nenhum dos parâmetros entre o uso do clobetasol e placebo; p>0,05. Baseado no protocolo utilizado neste grupo de pacientes, o propionato de clobetasol não demonstrou efetividade significante quando comparado ao placebo

Avaliação do potencial carcinogênico do cadmio no epitélio de revestimento do palato e gengiva de ratos: estudo morfológico e morfométrico

Cadmium (Cd) is a heavy metal that exerts a variety of toxic effects, chronic and acute, in exposed organisms. The aim of this study was to investigate the carcinogenic potential of Cd in the palatal and gingival epithelium of Wistar rats. Two groups of animals were studied: group 1 consisted of 5 rats exposed to cadmium chloride (CdCl2) in drinking water (300 mg/L) for 6 months; group 2 also consisted of 5 rats placed in the same conditions as those of group 1, but kept free of Cd for 6 additional months. Two other groups (C1 and C2) with the same number of animals, but not exposed to CdCl2, were used as a control for groups 1 and 2, respectively. All animals were weighed before and after the experimental period. After animals being killed, tissues of interest were fixed in solution of 10% formalin, processed by standard histologic techniques, stained with HE, and analyzed under light microscopy using karyometric and stereologic parameters. Loss of body weight, atrophy of the gingiva and soft-palate epithelium were the principal findings of this study, and verified only in the group 1 (p < 0.05). In conclusion, at the concentration tested, Cd presented no carcinogenic effect on the oral tissues within the experimental time period.Cádmio (Cd) é um metal pesado que exerce uma variedade de efeitos tóxicos, crônicos e agudos, em organismos expostos. O objetivo deste estudo foi investigar o potencial carcinogênico do Cd no epitélio do palato e da gengiva de ratos Wistar. Dois grupos de animais foram estudados: grupo 1 que consistiu de 5 ratos expostos a cloreto de cádmio (CdCl2) em água de bebedouro (300 mg/L) por um período de 6 meses; grupo 2 que também consistiu de 5 ratos submetidos às mesmas condições dos animais do grupo 1, mas permaneceu livre de Cd por um período adicional de 6 meses. Dois outros grupos (C1 and C2) com o mesmo número de animais, entretanto não expostos ao CdCl2, foram usados como controle para o grupo 1 e 2, respectivamente. Todos os animais foram pesados antes e após o período experimental. Após terem sido sacrificados, os tecidos de interesse para o estudo foram fixados em formalina a 10%, processados por meio de técnica histopatológica padrão, corados em HE, e analisados sob microscopia de luz, utilizando parâmetros cariométricos e estereológicos. Perda de peso, atrofia do epitélio da gengiva e do palato mole foram os principais achados deste estudo, e verificados apenas no grupo 1 (p < 0.05). Em conclusão, Cd não produziu efeito carcinogênico nos tecidos orais, nas condições experimentais empregadas neste estudo

Oral Mucocele of Unusual Size on the Buccal Mucosa: Clinical Presentation and Surgical Approach

Oral mucoceles are small-size, benign minor salivary gland pathologies. The most frequent localizations of these lesions are the lower lip mucosa. However, in some cases, they grow to an unusual size and hinder the preliminary diagnosis of mucocele. The purpose of this article is to report a case of a large oral mucocele with a diameter of 3.5 cm on the buccal mucosa of a 43-years-old male patient. The surgical procedure was carried out for a complete removal of the lesion